Individual
MARK GULOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
30581 STEPHENSON HWY, MADISON HEIGHTS, MI 48071-1610
(248) 589-1770
Mailing address
13636 DIX TOLEDO RD, SOUTHGATE, MI 48195-2432
(734) 283-2262
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
5101008280
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
008280
MI
207Q00000X
Family Medicine Physician
Primary
5101008280
MI
208D00000X
General Practice Physician
5101008280
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112881665
—
MI
05
—
113166549
—
MI
05
—
1942247689
—
MI
01
—
MG008280
BC/BS
MI
Enumeration date
06/01/2006
Last updated
11/09/2021
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